Archive for January, 2011

Medical Homes Should Match Patients’ Preferences and Needs, Say New NCQA Standards

January 31st, 2011 by Patricia Donovan

In case there was any doubt about the 'patient-centered' part, new NCQA guidelines for patient-centered medical homes (PCMH) direct practices to organize care according to patients’ preferences and needs.

That goes for teens, too. The 2011 standards provide direction for primary care providers in a sorely needed area — that of adolescent and teen care. To support patient-centered care for children, PCMH 2011 standards include parental decision-making, teen privacy and guardianship. Standards also cover communication between medical facilities about newborns’ lab results and guidelines for planning the transition from pediatric to adult care.

According to the NCQA, the new 2011 standards debut the next generation of the NCQA recognition program that designates high-quality primary care practices as patient-centered medical homes.

What's New for 2011:

Standards emphasize access to care during and after office hours, and managing care in collaboration with patients and families. Other aspects of patient-centeredness include providing services in patients’ preferred languages, helping patients with self-care and facilitating patient access to community resources.

PCMH 2011’s emphasis on patient feedback supports what is widely known as the “triple aim” (improving quality, containing costs and enhancing patient experience). NCQA is collaborating with the Agency for Healthcare Research and Quality (AHRQ) to develop a medical home version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey, a widely used evaluation of patient experience. NCQA expects to release CAHPS for medical homes in the second half of 2011.

Starting in January 2012, practices may receive additional NCQA Distinction by voluntarily reporting patient experience data.

Support for health information technology: Federal “meaningful use” language is embedded in PCMH 2011 evaluation standards, reinforcing incentives for practices to use health IT to improve quality.

The standards’ alignment with meaningful use creates a virtuous cycle: practices that meet PCMH 2011 requirements will be well prepared to qualify for meaningful use, and vice versa.

Download PCMH 2011 standards free of charge.

Does Medicare Cover for Recommended Prevention Services?

January 31st, 2011 by Jessica Fornarotto

A recent study has found that Medicare may not cover all preventive services. Read this week's issue of the DM Update to find out more about this coverage gap. Also, we present new data on heart patients and the effect of an obese patient's race on counseling sessions with physicians.

Are you ready to be an ACO in 2011?

January 27th, 2011 by Melanie Matthews

The accountable care organization (ACO) model creates integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. To learn more about this emerging trend, the Healthcare Intelligence Network has launched a survey on ACOs and is encouraging healthcare organizations to take the survey and share their awareness, readiness and implementation advice with the industry. Respondents who complete HIN's survey on ACOs by February 11 will be e-mailed a FREE executive summary of the compiled results. Responses will be kept confidential and will help us to shape future programs and products on this topic.

Describe your organization's ACO familiarity and development in our first annual ACO Benchmark Survey.

What Are the Top Technologies in Telehealth?

January 24th, 2011 by Jessica Fornarotto

Data monitoring and wireless technologies edged out land lines this year as the top technologies utilized in telehealth initiatives, according to the second annual Telehealth e-survey by the Healthcare Intelligence Network.

Powered by provisions in the Patient Protection and Affordability Act, healthcare delivery via telehealth and telemedicine is transforming wellness, disease management, medication management services and illness prevention while extending and enhancing access to critical healthcare services.

Survey Highlights:

  • About 70 percent of responding healthcare organizations use telehealth for clinical and non-clinical purposes.
  • Diabetes and heart failure are the top health targets of telehealth initiatives for 61 percent of respondents.
  • About 46 percent of organizations said reimbursement comes from private payors, while nearly 37 percent are reimbursed by public payors.
  • Nearly 64 percent of responding organizations say it is too soon to determine ROI from current telehealth efforts.
  • Of respondents with no telehealth programs, more than a third — 37.5 percent — plan to launch telehealth services within the next year.

New MRSA Treatment Guidelines

January 24th, 2011 by Jessica Fornarotto

Can social influences affect both weight status and loss? If so, which age group is most affected? Find out in this week's issue of the DM Update, along with the latest MRSA treatment guidelines. Our featured white paper describes how healthcare organizations react to MRSA outbreaks.

Should Physicians Fear Healthcare Reform?

January 24th, 2011 by Patricia Donovan

Last week's vote to repeal healthcare reform cemented the U.S. House of Representatives' stand on the law. Also last week, most physicians who took the National Physicians Survey (NPS) said they feared healthcare reform would weaken the quality of healthcare and hurt their bottom lines.

However, almost half of 3,000 physicians surveyed by Thomson-Reuters and HCPlexus on a range of healthcare issues said they did not know what an accountable care organization (ACO) was. Also, less than 25 percent were actively discussing ACOs, which offer physicians a chance to maintain and grow market share and improve profitability.

The most successful ACOs will be those whose physicians have an active hand in developing the ACO architecture, predicted Jeffrey R. Ruggiero, an attorney advising the Queens County Medical Society on its ACO development approach during last week's webinar on physician-owned ACOs.

Read more comments from Ruggiero.

In this week's Healthcare Business Weekly Update, we share a link to our first Healthcare Benchmarks video on Reducing Avoidable ER Use. HIN VP and COO Melanie Matthews narrates. We invite you to comment and share with your colleagues.

Video Benchmarks: How Healthcare Uses HRAs

January 20th, 2011 by Patricia Donovan

Top uses for health risk assessments (HRAs) in health promotion and disease management are featured in this new video, based on the 2010 Healthcare Intelligence Network survey on Health Risk Assessment Use. Includes commentary by HIN VP Melanie Matthews and Dr. Marcia Wade, senior medical director at Aetna Medicare. Part of the HIN Healthcare Benchmarks video series.

You can also download a summary of the survey results.

ACOs Not for Faint-Hearted Physicians

January 20th, 2011 by Patricia Donovan

The most successful accountable care organizations will be those whose physicians have an active hand in developing the ACO architecture, predicts Jeffrey R. Ruggiero, an attorney advising the Queens County Medical Society on its ACO development approach.

Contrary to past attempts to reform the healthcare system, there is a much greater willingness today by physicians to embrace ACOs, to give up some of their autonomy and to practice with peers, said Ruggiero during yesterday's webinar on Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges. The CMS Shared Savings Program, which will enable ACOs for Medicare beneficiaries beginning in January 2012, should be sharing its final rules by the end of this month, Ruggiero noted.

The most important consideration in ACO creation is who will manage the accountable care organization, said Ruggiero, a partner in the law firm of Arnold & Porter LLP. The best ACO leaders will share a strategic vision, will be able to articulate that vision and will encourage participation among their peers. He recommends that interested organizations identify a core group of 40 to 50 doctors who are willing to explore ACO formation. The Queens County Medical Society ACO, comprised of more than 700 local physicians, will be one of the largest physician-owned ACOs in New York State.

Beyond management considerations, the legal and regulatory ramifications of the ACO model can be daunting, said Ruggiero. More than 30 federal entities help to police the healthcare industry, and there are at least five types of state laws to consider when creating an ACO.

Ruggiero also walked through the antitrust considerations, fraud and abuse compliance, and the financial and administrative structure of a physician-owned ACO. Listen to an interview with Jeffrey Ruggiero.

Video Benchmarks: How to Reduce Hospital Readmissions

January 20th, 2011 by Patricia Donovan

Need ideas to reduce hospital readmissions, especially among Medicare patients? Watch this new video with strategies to curb rehospitalizations, based on our second annual survey on Reducing Hospital Readmissions. Features analysis by HIN VP Melanie Matthews and advice from Mary Cooley, manager of case and disease management at Priority Health. This video is part of the HIN Healthcare Benchmarks video series.

You can also download a summary of survey results.

Video: How to Reduce Avoidable ER Use

January 19th, 2011 by Patricia Donovan

We are very excited to announce a new video on strategies to reduce avoidable ER use, based on our 2010 survey on this topic. The video features analysis of survey results by HIN VP and COO Melanie Matthews, with commentary by Sara A. Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

This video is part of HIN's new Healthcare Benchmarks video series. We hope this data is useful to your organization. Please contact for more details on this topic, or download a complimentary summary of the survey results.